Year 2018 / Volume 110 / Number 1
Case Report
Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report

59-62

DOI: 10.17235/reed.2017.5187/2017

Javier Bueno, Rosa Burgos, Susana Redecillas, Manuel López, Joaquin Balsells,

Abstract
Background: We have recently demonstrated the feasibility of lengthening the duodenum in children with short bowel syndrome and a dilated duodenum. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. Herein, we report the successful application of this technique in an adult with ultra-short bowel syndrome. Case report: A 25-year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation. Only a megaduodenum stump that reached as far as the third portion (30 cm of length) and the colon up to the hepatic flexure in the form of a mucous fistula was retained. A gastrostomy tube drained gastric and bilio-pancreatic secretions (output range: 2.5-4 liters/day). The time spent on parenteral nutrition (3 liters/day; 1500 calories/day) and I.V. fluid (1.5-2 liters/day) administration was 24 hours per day. The patient underwent duodenal lengthening and tapering with 7 sequential transverse applications (5 of 45 mm and 2 of 60 mm) of an endoscopic stapler on the anterior and posterior walls of the duodenum, respecting the pancreatic parenchyma and end-to-side duodeno-colonic anastomosis. The final duodenal length was 83 cm. The pre-lengthening citrulline level increased from 13.6 micromol/L to 21.6 micromol/L one year post-lengthening. After 24 month of follow-up, the time on a parenteral pump was shortened to 9 hours during the night. The volume and calorie requirements were also reduced by half. Discussion: Duodenal lengthening may be effective as part of the autologous intestinal reconstruction armamentarium in adults with short bowel syndrome.
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References
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Bueno J, Burgos R, Redecillas S, López M, Balsells J. Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report. 5187/2017


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Publication history

Received: 23/07/2017

Accepted: 22/09/2017

Online First: 06/11/2017

Published: 12/01/2018

Article revision time: 57 days

Article Online First time: 106 days

Article editing time: 173 days


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